Chronic pain is at epidemic levels and has become the highest-cost condition in health care. This course uses evidence-based science with creative and experiential learning to better understand chronic pain conditions and how they can be prevented through self-management in our cognitive, behavioral, physical, emotional, spiritual, social, and environmental realms.
The goal of this course is to blend creative, experiential, and evidence-based teaching strategies to help participants understand chronic pain conditions and how a human systems approach can be applied to self-management strategies to reduce risk factors, enhance protective factors, and prevent chronic pain. There are four major objectives to the course;
1. Describe the prevalence, personal impact, and health care dilemma associated with chronic pain.
2. Recognize the clinical characteristics and underlying etiology of several common pain conditions and the peripheral, central, and genetic mechanisms of chronic pain
3. Based on the literature associated with risk and protective factors in the seven realms of our lives, learn specific strategies in each realm that can be employed daily to prevent chronic pain and enhance wellness.
4. Appreciate the value of a human systems approach to health care and how it can provide a basis for integrative, interdisciplinary, and individualized care to preventing pain and enhancing wellness.
CONTINUING EDUCATION CREDIT
Health Care Professionals
Health care professionals who participate in this CE activity may submit this certificate statement of participation to their appropriate accrediting organizations or state boards for consideration of credit. The participant is responsible for determining whether this activity meets the requirements for acceptable continuing education. Email your Coursera certificate statement of completion to your appropriate organization.

CH

An excellent continuing education course for those who are health professionals interested in chronic pain. In depth material providing good value.

NJ

Jun 26, 2018

Filled StarFilled StarFilled StarFilled StarFilled Star

I found this course very effective in helping me manage my persistent pain. The advice and self-help techniques were very illuminating.

From the lesson

Introduction to the Course (Week 1)

In this first module, we will introduce you to the course and present an overview of the topics to be discussed and format of the course. We will also present information about receiving Continuing Education, joining the International Myopain Society, and supporting the Campaign for Preventing Chronic Pain

Taught By

Dr. James Fricton, DDS, MS

Professor and Pain Specialist

Transcript

Hi, this is James Fricton again. I'm here from the University of Minnesota, and we're talking about the dilemma of chronic pain. And this part, which is part two, is the healthcare dilemma that chronic pain poses. I consider myself, as a pain specialist. I call pain buster, like the ghost busters. And there are so many issues that pain patients have that we need to examine, to evaluate, and see if we can prevent them. As in this slide it shows that there, these patients often have treatment failure with medications and surgery. I've had one patient that had 30 surgeries to their jaw over the years. It was like getting their teeth cleaned. And there was many psychosocial problems too as we'll review in this module. Depression anxiety is common. There is a lot of overlooked pain diagnosis. People ignore, for instance, myofascial pain commonly because it's in the muscles. You can't see it. You can't image it. And there's a lack of training on most doctors in understanding chronic pain conditions and how to prevent them. There's a lot of trial and error treatments. I'll try this, see if works. But if doesn't, well, then we can try something else. And health plans typically favor, by their reimbursement schedules, surgeries, hospitalizations, and injections, large interventions, and they do not reimburse or support prevention very often. And the risk factors are frequently not addressed as a result of that. It takes time to reduce risk factors. To teach patients protective factors to prevent pain. And in addition there are a lot of iatrogenic side effects for medications and surgery, and sometimes the side effects are worse than the original problem. As a result, there's a lot of doctor shopping. Patients go from doctor to doctor trying to find an answer to the problem. It's a, lonely endeavor, indeed. So let me examine what happens with somebody who is injured and develops chronic pain. Well this chart illustrates the progression that can occur from acute to chronic pain, and how risk factors play a role. Right here to the left is the pain onset. Now this frequently comes on with trauma or an injury. But at least half the time it comes on without any initiating event. There was no trauma, no injury. It just came on overnight. In most of these situations it's the result of some type of repetitive strain. Now the problem becomes acute. And in this case, as a result of acute pain, what do you do? You brace, you tense your muscles, you clench your teeth. And this repetitive strain causes the muscles to be more painful over time. Postural habits result in a lot of behavioral problems, sleep problems for instance. Stress will result. And that becomes and leads to patients becoming into the chronic pain category. Once chronic, once a pain becomes chronic, then of course it brings on more stress, more anxiety, patients wondering what's causing my pain, I don't know. They have sleep disturbance depression is common. And these chronic pain patients, if these risk factors continue, then it develops into an intractable problem. Treatments don't work, surgery doesn't work, medications don't work. They become depressed. They often become disabled. They have conflicts within their relationships. They have lower self-esteem. So all of these characteristics eventually end up in chronic pain patients. They do the best they can to tolerate the pain, but it's difficult. And we want to try to avoid the obviously intractable pain or chronic pain by preventing it. By the end of this cycle of chronic pain patients are quite complex. Here's some studies that we've done over the years. The number of previous clinicians that we've seen prior to seeing myself is 4.5. The number of years the patients had pain was 3.8. The average out of po, out of pocket costs for pain treatments was $4 thousand. Patients with multiple diagnosis 65% and psychosocial problems were very common at 75%. One day I woke up, I always read the newspaper every day, the Star Tribune and I saw this on the front cover. And I though, oh my gosh. A man abducts a dentist. I'm a dentist. He kills himself. And then I read the article and it's about years of pain is blamed for the hostage-taking suicide. Patient had a simple filling done on the back tooth, opened the mouth maybe too wide, strained the jaw started developing pain in the tooth, started developing jaw pain, it spread into headaches and neck pain and back pain. He went to lots of different doctors and ultimately he became depressed, and, he fe, he felt like he couldn't live this way. And he wanted to make sure that the dentist knew that he was the cause of the, or the initiating event in the pain. It's a sad situation, but we need to prevent this and we can prevent it. But one of the things we need to do is recognize pain diagnosis. In this study by Lipton we found that 52% of headaches were undiagnosed prior to coming to his clinic. So we need to recognize these pain diagnosis. And in this course you will find, and evaluate, patients and find what are the diagnoses that cause pain. But we also need to make sure that we do the same treatment. Over-treatment in these patients is very common. This is a x-rays, dental x-rays that were given to me by a patient who had persistent tooth pain and jaw pain. And as you can see something a little bit unusual about these x-rays. If you're a dentist you can recognize it right away but if you're not a dentist you can see that there's two teeth here that have not had root canals, now it's surprising the patient in for their pain had root canals in almost every tooth why did they leave two? And I'm just being facetious of course. But this is a sad situation because none of the root canals were needed and none of them helped the patient. This type of over treatment is common in back pain and neck pain and headaches as well as oral facial pain. Because surgery doesn't always work. This study by Nouyen in 2011, found that the patients reported a year later that their surgery did not improve the pain 72% of the time. Whereas, in a comparable group of patients with non-surgical treatment, such as physical therapy and medications, it did not improve the pain approximately 25%. So sometimes surgery is a risk factor for continued pain. We have to be very cautious about proceeding with any type of surgical event, or intervention. And then of course medication is not a panacea either, patients with medication failures are common. And they have a lot of different complains about the use of medication. Sometimes it took too long. It did not relieve all the pain. It didn't always work. The pain returned. And it came with a lot of side effects. And then there's rebound pain, where the medications themselves are actually causing pain to continue. As this cartoon depicts, I feel a lot better since I ran out of those pills you gave me. And, as a result of that, there's a lot of opioids prescribes for chronic pain patients. And, abuse of opioids is a huge problem, right now, in our society. There are clinics right now set up and different states that all they do is give out opiate medications. And they make a ton of money. They, none of them are particularly useful but the patients of course are dependent, addicted to the opiate medications. And there is a lot of unintentional deadly overdoses as a result of medications used every year. The nonmedical use of opioids Where the patients either give them to friends or family, or sell them on the streets, is huge. And the costs of opioid abuse is expensive, it's 72, estimated at $72 billion dollars. And emergency re, room visits are also common with adverse events, overdoses, where they show up at the emergency room estimated at half a million times per year. So, and then there's the adversity of ads alone. So if you are taking medication, particular opioids, here are a list of different medication adverse events that occur. And the number of one or more adverse events compared to a placebo is very high, over 50%. And of course there's withdrawal symptoms if you don't have it, there's lack of efficacy, dry mouth, nausea, constipation, itching, pruritus, dizziness, drowsiness, vomiting, all of these are side effects from opioid medication. And then you have the impact that it has on the workplace. There's a lost productive time estimated at $61.2 billion per year due to chronic pain, with 76.6% due to reduced work performance not missing work or absenteeism. Over half, 52.7% of the workforce surveyed had pain in the past two weeks. And of course, sitting at a desk working on a computer, very stressful ergonomically, can cause neck pain, shoulder pain, wrist pain. And 12.7% of all workforce lost productive time in the last two week period due to pain. And of course, neck pain, headaches, back pain are all very common. And as a result of this, health providers themselves become very frustrated with these patients, too. A lot of them accuse them of, drug addiction and and secondary gain and, and increasing the number of providers they see and medications and treatments just to get disability. So, as Mr. Boffo here says, going with the flow, the worst case scenario. We're not really out of Novocain, I just feel like clocking someone. But as much as some providers are frustrated with chronic pain, other providers benefit significantly. There's one case history of a hospital, that offered, decided to offer incentives to perform spinal fusions. And as a result of that as you would expect of course the rate of surgeries increased dramatically in that hospital and of course so did the hospital profits everybody was happy the surgeons income rose however whatever happened to the patients some of them got better and many of them did not get better and needed repeat surgery which of course would benefit the hospital again. So, all of these problems are a problem that we all have with chronic pain. They're prob, let me just to summarize. There's problems with costs, frustrated providers, the number of co-morbidities, the drug overuse and adverse events, particularly with opioids, the fragmented care, the bad diagnoses, or the overlooked, or misdiagnoses, the lost productivity at work, missing work, the disability, the progression of acute to chronic pain, and of course no effort towards prevention. So all of these makes it a chronic pain problem for all of us. So let's do what we can. Let's try to fix it. Let's prevent chronic pain. Thank you very much. [SOUND] [BLANK_AUDIO]

Explore our Catalog

Join for free and get personalized recommendations, updates and offers.

Coursera provides universal access to the world’s best education, partnering with top universities and organizations to offer courses online.